Sunday, February 05, 2006

Shotguns for the Suicidal?

The field of mental health has, to me, always been a profession where we help people to both learn to help themselves and protect them from harm, so it was with a degree of both dismay and incredulity that I saw an article in The Sunday Times of London, February 5, 2006.

It seems that a debate among nurses in Great Britain will be taking place shortly and that's something I would have missed if it weren't for the topic to be discussed: giving blades to self-harmers. My thinking is that would be tantamount to advocating for shotguns for the suicidal. I don't intend to sound like I'm taking this lightly, I can assure you.

One of the nurses interviewed stated that self-harm patients (aka those who engage in SIB or Self-Injurious Behavior) need clean, sterile blades for their cutting rather than razor blades, dirty knives, broken glass or tin cans. This poses another question in my mind: Do SIB patients intend to cause flesh injuries or start an infection that could endanger their lives? I don't believe they do intend to cause an infection and it is unlikely that they would choose particularly dirty implements. The few SIB patients I saw in the hospital all used clean, new razor blades or kitchen knives. All of them let other patients and staff know they had cut themselves and were given immediate medical care.

The rational also used to advance this proposal is that we provide clean needles for drug addicts, so why not clean blades for SIB patients? I do see a connection, but it's a bit beyond my reach to explain in terms of the neurobiology behind it. SIB patients may, in some way, be addicted to this behavior. We do know that, when interviewed about why they cut themselves, they will say because it makes them feel better and they have a sense of relief after the cutting. I once saw a woman who had so many cuts on her arms that both of them were covered in straight white welts from just above her wrists to the beginning of her shoulders.

One advocate not only favors the clean "sharps," but believes it would be a good idea to sit there as the patient carves away.

Now, I come to yet another question: Is or isn't SIB a form of mental disorder and can a person with such a disorder make a rational judgment about their safety? The question of civil liberties has been brought into this discussion here in the US where patients are seen as having a right not to take medication or accept treatment, unless they are deemed a danger to themselves or others. Unless someone makes that determination, they can do as they please.

What do you think?

Sunday, December 04, 2005

The Funless Follies

Somewhere around 1967 or so, mental health was receiving intense scrutiny with regard to the large state-run hospitals which resembled small self-contained towns. Some of these hospitals had workshope to provide the patients with everything they needed from clothing to furniture for the wards.

I recall going to one much later and still being impressed with how much of a throwback it was. I felt as though I had just walked into "The Snake Pit" (1948) but where was Olivia de Havilland? I walked down a long white corridor with an arched ceiling. At the end was a thick metal door with a tiny wired-glass window in it. The window was filled with bits of faces and when the attendant opened the door, the doorway bristled with a confused blend of faces, coats, hats and arms, all moving like so many Pandora's heads. I was in the modern equivalent of that epic film and it was frightening.

As I walked with my guide down the hallway on the unit, we were enmeshed in this sea of female humanity as they reached, silently, out to touch me. One took my hand and walked by my side. Along the hallway were similar closed metal doors with tiny wired windows. Some windows had a face staring blankly out, others were empty. My guide told me these patients were being kept in their rooms for some infraction of the rules or unruliness that prior evening. What could they have done? The unit was bare. A large day room sat dark and forbidding at the end of the corridor and a window seat, almost laughablely placed for a view of the stone courtyard, was empty. It looked as though it had never been occupied and I envisioned one of those ropes they use at restaurants and theatres to keep the crowd back. This rope was invisible.

Not a word was spoken and we were surrounded by perhaps 30-40 women. They just moved with us like sea weed in the ocean. All of them were wearing winter coats and the temperature inside hardly warranted it. My guide told me that was because rooms were locked during the day and the patients needed their coats in order to go outside for meals in the main dining hall. What about when it rains, I thought. Do they have umbrellas or hats or boots? No, just coats.

I had heard about a documentary film by Frederick Wiseman, called "Titicut Follies" and I thought I should see it. It took years before I stumbled across a copy and I watched it just a few months ago. Yesterday, I watched a bit of it again, meaning to recommend it to a friend since it is a historic piece of Americana a la state mental health hospitals.

The film is disturbing, offensive to the senses and displays the cruelty of petty power over helpless people. Most offensive is the "ring master" whose attempts to humor come off all the more offensive.

See it, if you can and remember that this film played an important role in mitigating for more humane treatment of the mentally ill. I've been there, I've seen this cruelty in action and I think we still have a way to go.

Only About Films

I've decided that since I love films so much, I'm going to write exclusively about films. I find them not only entertaining, but they can be clearly a rent in the current view of our culture. Documentary films, in particular, should they come my way, will be given precedence over others.

Attention to anyone making and distributing documentary films.
I'd either like to receive a DVD of your film or be placed on your critic's list for viewing them prior to opening. Yes, I live very near Manhattan and that's my viewing city of choice.

Saturday, April 30, 2005

Runaway Bride Saga

Put yourself in this position. You're marrying into a wealthy, prominent family and your wedding party will include 14 brides and 14 groomsmen, you've attended 8 bridal showers and there are 600 guests coming to the reception. Would you be a little nervous? Would you be able to tell your parents and future in-laws that things were more than you could handle and things needed to be scaled back? Well, the "runaway bride," Jennifer Wilbanks did what she'd probably been doing all along to help with her stress; she ran. In fact she's a marathon runner and there are several intriguing facts about this case Forget about the policemen giving her a teddy bear to calm her down. What 32-year-old woman needs or wants a teddy bear? It's almost insulting.

The police say she cut her hair to disguise her appearance. I've worked too long in the mental health field not to know that cutting your hair, especially under circumstances of stress, is a sign that cause we in the mental health fied concern. It usually preceeds something drastic and we see it as a warning sign.

Jennifer Wilbanks, too, is a nurse; a profession where people who wants to help other go and it may have been in this spirit of not wanting to hurt anyone that she trudged along with this weighty wedding. She couldn't say no because too many other would be disappointed, so she wall sacrificing herself. There came a time, however, when it was too much and she bolted. Poor plan for her with little money and no luggage she boarded a bus Vegas. What would she do there? She then boarded another bus to New Mexico, walked or ran from the bus terminal ( no pphones there?) and ran or walked to the 7/ll store. I tend to think she ran because she knows what a "runner's high" can do for you; it's like a tranquilizer and it helped her make that all-important phone call.

What do we know about her and why she did this? The pundits seem to all have opinions and I tend to think they are talking too soon and with too little information. Did she commit a crime or not? Only time and her local police will tell us that.

Meantime, let this family try to understand where they do from here. They must be feeling like they're in the middle of a whirlwind and Dorothy is nowhere%